Provider Demographics
NPI:1417392416
Name:PERGOLA MARKETING INC
Entity Type:Organization
Organization Name:PERGOLA MARKETING INC
Other - Org Name:FAMILY FITNESS CENTERS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-375-1116
Mailing Address - Street 1:4028 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1798
Mailing Address - Country:US
Mailing Address - Phone:727-375-1116
Mailing Address - Fax:727-375-1574
Practice Address - Street 1:4028 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1798
Practice Address - Country:US
Practice Address - Phone:727-375-1116
Practice Address - Fax:727-375-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6989150001Medicare NSC
FLHP761AMedicare PIN